The role of socio-economic status and perinatal factors in racial disparities in the risk of cerebral palsy

Abstract

Aim: To determine whether racial disparities in cerebral palsy (CP) risk among US children persist after controlling for socio-economic status (SES) (here indicated by maternal education) and perinatal risk factors. Method: A population-based birth cohort study was conducted using the Autism and Developmental Disabilities Monitoring Network surveillance and birth data for 8-year-old children residing in multi-county areas in Alabama, Georgia, Missouri, and Wisconsin between 2002 and 2008. The birth cohort comparison group included 458 027 children and the case group included 1570 children with CP, 1202 with available birth records. χ2 tests were performed to evaluate associations and logistic regression was used to calculate relative risks (RR) and adjusted odds ratios (OR) with 95% confidence intervals (CI). Results: The risk of spastic CP was more than 50% higher for black versus white children (RR 1.52, 95% CI 1.33-1.73), and this greater risk persisted after adjustment for SES (OR 1.35, 95% CI 1.18-1.55), but not after further adjustment for preterm birth and size for gestational age. The protective effect of maternal education remained after adjustment for race/ethnicity and perinatal factors. Interpretation: Maternal education appears to independently affect CP risk but does not fully explain existing racial disparities in CP prevalence in the US. What this paper adds: The risk of spastic cerebral palsy (CP) was higher in black relative to white children. Disparities in maternal education, an indicator of socio-economic status, did not fully explain the greater CP risk among black children. Factors associated with higher maternal education may help protect against the risk of spastic CP. This article is commented on by Oskoui on pages 791-792 of this issue.